Wednesday, April 20, 2016

Mrs. Fennec called, asking for an urgent appointment. Mary had an afternoon slot open, and put her in.

She came in with her dog. This isn't uncommon in my practice, so I didn't think much of it.

Dr. Grumpy: "So what's going on? Mary said you had an emergency?"

Mrs. Fennec: "Yes! Fluffy ate my bottle of Strokoxx!"

Dr. Grumpy: "Uh, are you okay?"

Mrs. Fennec: "I'm fine! But what should we do about Fluffy?!!!"

(I look at Fluffy. He looks at me and cocks an ear to the side.)

Dr. Grumpy: "Well, you should take him to your vet to get this checked out."

Mrs. Fennec: "BUT YOU'RE THE ONE PRESCRIBING THE STROKOXX!!!"

Dr. Grumpy: "Yes, but I have no idea what it does to dogs. Or how to handle it. Or much about dogs at all. Who's your vet? Why don't I call and tell them what's going on, and you can head over there..."

Mrs. Fennec: "It's YOUR medication. You prescribed it! So you should be handling any issues it causes."

Dr. Grumpy: "Well, yes, as far as people go. But not dogs."

Mrs. Fennec: "You're refusing to treat Fluffy because he doesn't have insurance!"

Dr. Grumpy: "This has nothing to do with money. I'm not a veterinarian. You need to take him to someone who knows what to do for him."

Mrs. Fennec: "This is ALL YOUR FAULT, and I'm going to send you the vet's bill!"

(She got up and stomped out. Fluffy, I swear, looked back and winked at me.)

Wednesday, April 13, 2016

Ms. Stannum: "I need to see the doctor, but want to ask some questions first."

Mary: "Okay, what can I help you with?"

Ms. Stannum: "I'm having terrible problems on my left side, and I need to know what's going on. But I can't have any tests, so is he the kind of doctor who will order them?"

Mary: "Well, that's something he would have to decide during the appointment, but I can tell you that he does order MRI's and labs, and...."

Ms. Stannum: "DIDN'T YOU JUST HEAR ME? I said I can't have any tests! I'm deathly allergic to the metal used in needles to draw blood and those electrodes they put on your skin!

Mary: "All right, but..."

Ms. Stannum: "And the magnetic rays and X-rays that scanners give off devastate me. I mean, I've had them in the past from all my other neurologists, but then I'm bed-bound for weeks afterwards. WEEKS. Last time I had to take short term disability until I could recover from the effects they have on my brain waves."

Mary: "Maybe you..."

Ms. Stannum: "And I can't take any pills. The chemicals they use in them are all poisons to me. I've nearly died from them thousands of times. LITERALLY. THOUSANDS! So I need a doctor who can help me get better, but who won't make me have any tests or take any pills."

(pause)

Mary: "I don't think Dr. Grumpy and you would be a good match. You might want to try another office."

Monday, April 11, 2016

Parkinson's Disease is something I deal with a fair amount. As most know, it's a progressive neurological disease typically characterized by tremor, imbalance, and slowness of movement.

And that's all I'm going to say about it here.

So why did I bring it up? Because the man behind the disease is fascinating. Mostly remembered now only by the neurological disorder he described, there was a lot more to him. Probably one of the more remarkable figures of his (or any) time.

James Parkinson was born on this day in 1755. His father, John, was a London pharmacist and physician. While a medical student, in 1777, James and his father received medals for successfully resuscitating a man who'd hung himself.

During medical school he wrote a pamphlet about his
experiences called "The Medical Pupil." Perhaps this could be seen as an
early example today's med student blogs. In words that still ring true
240 years later, he opined that "a sympathetic concern, and a tender
interest for the sufferings of others, ought to characterize all those
who engage themselves in the profession, the object of which should be
to mitigate, or remove, one great portion of the calamities to which
humanity is subject.”

Preach it, brother James.

In 1784, upon John's death, James took over the practice. It was a successful one, treating rich and poor alike. He also served as the supervising physician at a large local mental institution. He married Mary Dale, and they had a total of 8 children, 6 of whom survived to adulthood.

Parkinson was politically active and, for the time, radical. He strongly supported equal rights for the poor (OMG!), voting rights for women (gasp!), and the inclusion of "ordinary citizens" as a major portion of government. He campaigned extensively for decent treatment and
legal protection of the mentally ill, realizing that those with
serious illnesses were often incapable of recognizing their actions.

He wanted annual elections to make sure parliament turned over with "new minds" frequently, and supported the French Revolution across the channel. He wrote and published numerous political pamphlets, but to protect his family and practice wrote under the pen name "Old Hubert." When a political group he was involved in was falsely accused of plotting to assassinate King George III (the Pop-Gun Plot), Parkinson refused to testify against his friends. Eventually all charges were dropped when it was revealed they were trumped-up by political opponents.

During his medical career he published a treatise on gout and went on to write the first English language description of acute appendicitis. He and his son (also James, and also a doctor) were the first to prove that death from appendicitis was due to visceral perforation and infection.

As a member of the Association of Apothecaries (later its president) he saw a key act passed in 1815 that, for the first time, regulated the standards to which doctors and pharmacists had to be trained. He was also instrumental in passing laws concerning apprenticeships, setting goals for training and protecting the apprentice from abuse.

He wrote medical & science columns for popular newspapers on such varied subjects as chemistry, nosebleeds, and hypochondria, and also published scientific papers on topics as disparate as lightning, fossils, and geology.

In the 1810's, based on observations of both his own patients and individuals he'd seen walking around London, he first recognized the characteristic tremor and shuffling gait of the disease that today has his name. He also differentiated between the types of tremors commonly seen - a key diagnostic point still used by neurologists today.

In 1817 he published his landmark piece "An Essay on the Shaking Palsy" in which he described the main features of the disorder. The accuracy of the paper in describing the condition is made all the more remarkable by the fact that neurology as a field didn't exist at the time. Jean-Martin Charcot, the Frenchman who would go on to found my medical specialty, was born 8 years later in 1825. It wasn't until 1877, 60 years after Parkinson's essay, that Charcot himself named the condition Parkinson's Disease. His English colleague, William Gowers, agreed with Charcot's eponym.

Sadly, this discovery obscured many of his equally remarkable accomplishments.

Besides those interests mentioned above, Parkinson's scientific curiosity led him in many directions. He examined rock specimens at length and wrote a breakthrough treatise on the sediment patterns and fossils seen through the British Isles, recognizing the organization and significance of different rock strata.

He authored 2 books on fossils from around the world, describing them as earlier stages of currently living animals (Darwin's theory of evolution wouldn't be published for another 40 years). He also did his own black & white illustrations for the books, while his daughter did the color plates.

A species of Ammonite, a long-extinct relative of the modern octopus and squid, was named after him. So was an ancient branch of the turtle family. He has the unusual distinction among scientists of having both a disease and fossils attached to his name.

In 1823 the Royal College of Surgeons presented him with an award for his extensive body of work, noting “The fruits of your exertions are distinguished by the stamp of simplicity and truth. They express the most laudable zeal in the pursuit and the promulgation of knowledge, for the benefit of mankind.”

James Parkinson died on December 21, 1824 of a stroke, very close to where he was born and spent his entire life and practice. He was buried at St. Leonard's church, though no stone was placed and the exact location of his body is unknown.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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